After his training, McHugh held various academic and administrative positions, including Professor of Psychiatry at
Weill Cornell Medical College (where he founded the Bourne Behavioral Research Laboratory), Clinical Director and Director of Residency Education at the
New York Presbyterian Hospital Westchester Division. After reportedly being passed over for the Cornell chair in favor of
Robert Michaels, he left New York to become Chairman of the Department of Psychiatry at the
University of Oregon. During the 1960s, McHugh co-authored papers on hydrocephalus, depression and suicide, and amygdaloid stimulation. From 1975 till 2001, McHugh served as the Henry Phipps Professor of Psychiatry and the director of the Department of Psychiatry and Behavioral Science at the
Johns Hopkins University. At the same time, he was psychiatrist-in-chief at the
Johns Hopkins Hospital. He is currently University Distinguished Service Professor of Psychiatry at Johns Hopkins University School of Medicine. His research has focused on the neuroscientific foundations of
motivated behaviors,
psychiatric genetics, epidemiology, and
neuropsychiatry. In 1975, McHugh co-authored (along with M. F. Folstein and S. E. Folstein) a paper entitled "Mini-Mental State: A Practical Method for Grading the Cognitive State of Patients for the Clinician". This paper details the
mini mental state exam (MMSE), an exam consisting of 11 questions, that assesses patients for signs of dementia and other forms of cognitive impairment. In 1979, in his capacity as chair of the Department of Psychiatry, McHugh ended gender reassignment surgery at Johns Hopkins Hospital. In 2017 the clinic was reopened." In 1983, McHugh and colleague Phillip R. Slavney co-authored
The Perspectives of Psychiatry, which presented the Johns Hopkins approach to psychiatry. The book "seeks to systematically apply the best work of behaviorists, psychotherapists, social scientists and other specialists long viewed as at odds with each other". Throughout the 1990s, McHugh was active in debunking the idea of
recovered memory, the idea that people could suddenly and spontaneously remember childhood sexual abuse. McHugh treated author
Tom Wolfe for depression suffered following coronary bypass surgery. Wolfe dedicated his 1998 novel,
A Man in Full to McHugh, "whose brilliance, comradeship and unfailing kindness saved the day." In 2001, McHugh was appointed by President
George W. Bush to the
President's Council on Bioethics. The Council was charged with the task of making recommendations as to what the U.S. federal government's policy regarding embryonic
stem cells should be. McHugh was against using new lines of embryonic stem cells derived from in vitro fertilization but was
in favor of the use of stem cells derived from
somatic cell nuclear transfer (SCNT). In SCNT, the nucleus of a cell is removed and replaced by another cell nucleus. McHugh felt that cells created in this fashion could be regarded as merely tissue, whereas stem cells taken from embryos caused the killing of an unborn child. In 2002, McHugh was appointed to a lay panel assembled by the
Roman Catholic Church to look into
sexual abuse by Catholic priests in the United States. This appointment was controversial, as McHugh had previously served as
expert witness in the defense of numerous priests accused of
child sexual abuse.
David Clohessy, Director of the
Survivors Network of those Abused by Priests, was appalled at McHugh's inclusion. McHugh said the furor surprised him, as his appointment was not related to recovered memories, telling the
New York Times: "These are legitimate cases; they are not problematic cases; and they are scandalous cases". McHugh was featured in a 2017
Netflix documentary,
The Keepers, for his role in the defense in the 1995 trial,
Jane Doe et al. v. A. Joseph Maskell et al., which was a case involving the sexual abuse of two women at the hands of a Catholic priest, Father
Joseph Maskell. ==Gender, sexuality and gender-affirming surgery==